Bill C-7 (Historical)

An Act to amend the Criminal Code (medical assistance in dying)

This enactment amends the Criminal Code to, among other things,
(a) repeal the provision that requires a person’s natural death be reasonably foreseeable in order for them to be eligible for medical assistance in dying;
(b) specify that persons whose sole underlying medical condition is a mental illness are not eligible for medical assistance in dying;
(c) create two sets of safeguards that must be respected before medical assistance in dying may be provided to a person, the application of which depends on whether the person’s natural death is reasonably foreseeable;
(d) permit medical assistance in dying to be provided to a person who has been found eligible to receive it, whose natural death is reasonably foreseeable and who has lost the capacity to consent before medical assistance in dying is provided, on the basis of a prior agreement they entered into with the medical practitioner or nurse practitioner; and
(e) permit medical assistance in dying to be provided to a person who has lost the capacity to consent to it as a result of the self-administration of a substance that was provided to them under the provisions governing medical assistance in dying in order to cause their own death.

Criminal Code

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Mr. Speaker, many great amendments were proposed at committee that would have helped the situation. Some of those amendments will be considered in the House. I am hopeful that those considering this bill in the other place will also take a look at some of the amendments.

One amendment that would make a big difference to people living with disabilities is the requirement that a doctor or a nurse practitioner not be the one to initiate the conversation. If people come forward and say that they would like more information about MAID, then at that point the doctor or the nurse practitioner would engage and provide that information.

It should be clearly established in the law that people cannot have it suggested to them that they should consider it. If it is not something they want brought up and suddenly they are told by the system that they should really think about dying, it completely changes their engagement with the system.

Why not have in place an amendment that says that the first person to bring it up should be patient, not the doctor? We put that forward at committee. Unfortunately it was voted down, but I am hopeful people in the other place will consider this as something to maybe put in the legislation.

[Peter Kent, Conservative, Thornhill, ON]

Mr. Speaker, when I last rose in the House to speak to the matter of physician-assisted death in 2016, I noted that the legislation then before us, Bill C-14, was neither the alpha nor the omega in the continuing conversations on the topic that Canadians have had for decades.

The Supreme Court had forced that legislative moment on reluctant politicians with the Carter decision, although the conversation had been simmering across society from the last century into this one.

However, in 2016, Bill C-14 brought us nowhere near where the Supreme Court had ruled Parliament must go. It was an interim step. It was a very cautious first step that was driven home with the Truchon-Gladu ruling in Quebec, which ordered that a class of people denied eligibility for medical assistance in dying by Bill C-14 were indeed entitled to access medical assistance in accordance with the Carter ruling.

The legislation before us now, Bill C-7, as amended in committee, under-amended I believe, and I will get to that in a moment, goes considerably beyond Truchon-Gladu. That said, the past five years of medically assisted death has brought Canadian society to a much more accepting place than in 2016; that increased acceptance of the practice justifies the additional provisions included in Bill C-7.

To my point that Bill C-7 was under-amended by the justice committee, the Conservatives hold that, for a variety of reasons, not least of which the WE scandal prorogation that wasted six valuable weeks in the summer, Bill C-7 has been indecently rushed through committee with not nearly adequate consultation. In the shadow of time allocation, signalled by the Liberal House leader last Thursday, it seems it will be denied adequate debate now during report stage.

This flawed process makes even more important the separate full and comprehensive parliamentary review of medically assisted death demanded by Bill C-14.

At committee, the Conservatives proposed nine amendments to better protect vulnerable groups, reasonable amendments, all rejected by the Liberals, but amendments which I hope Senate colleagues will consider in the upper house. I say that with some expectation of that actually happening as a result of testimony before the Senate's legal affairs committee last week by the Minister of Employment, Workforce Development and Disability Inclusion. In fact, the minister endorsed exactly the same point as was proposed by one of the Conservative amendments, which was voted down by Liberal members of the House justice committee. She said, unambiguously, that health practitioners should not be allowed to discuss the issue of assisted dying until a patient asked.

Admittedly, this is a particularly difficult issue and one of context. I understand why anyone, but particularly a person with disabilities might feel improperly, even terrifyingly pressured, depending on how the matter is raised by a doctor. There is quite a difference between a physician informing of a range of choices facing a seriously ill patient and directly recommending assisted death.

The Canadian Nurses Association advised the Senate committee that the law should explicitly allow doctors to raise the issue with patients, as did the Canadian Association of Medical Assistance in Death Assessors and Providers. Dr. Stefanie Green told the committee that it would be unprofessional not to lay all the options on the table. I am sure we will all follow Senate dealings on this question very closely.

The disability inclusion minister testified as well before the Senate committee that she was open to considering an amendment to Bill C-7 that would impose a 12-month sunset clause on the proposed ban on individuals suffering solely from mental illnesses to seek an assisted death. Legal experts have made it abundantly clear that if that clause remains in Bill C-7, it is destined, almost certainly, to return to the Supreme Court where it will almost certainly be found to be unconstitutional. This is another consideration to watch closely.

Over the years since Bill C-14 was passed, and now as Bill C-7 is being rushed to law, a dark cloud has hung over discussion and debate, and that is the government's still unkept promise, a broken promise actually, to better provide choice, a meaningful alternative to physician-assisted death.

In 2015, the Liberals made a campaign commitment to invest $3 billion in long-term care, including palliative care. In fact, the importance of access to palliative care and end-of-life decision-making was one of the few unanimous points of agreement in the special joint committee's report to Parliament in February 2016.

The government promised to expand the availability of accessible, affordable, acceptable palliative care for all those who for reason of conscience, faith or choice decided not to avail themselves of physician-assisted death. The Liberals' inconsistency in the matter of choice in other circumstances aside, this is a promise that must be fulfilled. It is essential that hospice and palliative care capacity in the country be vastly expanded to provide for those who would choose a meaningful alternative to MAID.

As I said in the House four years ago, my personal decision, which will determine my vote on this legislation, is a product of three individuals and their experiences and my own.

In my previous life as a journalist, I followed closely the unsuccessful legal crusade of Sue Rodriguez, as ALS steadily increased its smothering, deadly grip on her. I was seized by her rhetorical question posed to all Canadians, “If I cannot give consent to my own death, whose body is this? Who owns my life?”

When I first came to Parliament 12 years ago, I became close to another thoughtful, courageous Canadian, a fellow MP, the Hon. Steven Fletcher, Canada's first quadriplegic MP, re-elected three times. Steven did not give up after a life-changing accident. He met immense challenges and he overcame them.

However, in two private members' bills tabled several years ago, which I seconded, and in testimony before the justice committee in January 2016, Steven made a powerfully convincing argument for self-determination to one day make a final decision. Steven argued for a law by which an individual could make one's own decision based on one's own morals and ethics, but under guarantee there would be no pressure on that person from society, family, friends, or the facility in which he or she might be.

I was also powerfully persuaded by the tragically tortuous passing of my brother-in-law, a brilliant academic, by Alzheimer's. I informed the House during debate on Bill C-14 that should such an end one day face me, I would surely compose an advance directive and that one way or the other it would be fulfilled.

Finally, as a cancer survivor, I have had many hours of reflection during treatment and since to personally ponder the issues involved in medically assisted death and Sue Rodriguez's quite powerful rhetorical question: Who owns my life?

I am honoured to participate in this debate on Bill C-7 as I was with Bill C-14. Bill C-7 would correct the major deficiencies of the original legislation, but it is still deficient. Whatever happens in the Senate, I hope the parliamentary review, which should have occurred before consideration and passage of Bill C-7, will now more thoroughly examine this evolving law and properly lead to eventual amendments, chief among them measures to better ensure protection of Canada's most vulnerable.

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the President of the Queen’s Privy Council for Canada and to the Leader of the Government in the House of Commons]

Mr. Speaker, when we talk about the beginning and the end of this issue, I suspect we will still not be at the end, that ongoing discussions will take place both formally and informally among parliamentarians going forward.

I respect the member's belief in Parliament. If an amendment is brought forward that has already been voted on and defeated in the House by elected parliamentarians, does the member support that very same amendment being brought forward in the Senate chamber where the Senate would pass something on which a clear decision was by members of Parliament?

[Peter Kent, Conservative, Thornhill, ON]

Mr. Speaker, in many instances that has been the parliamentary practice and tradition. However, the testimony of the Minister of Disability Inclusion last week before the Senate committee's pre-study of Bill C-7, and her unambiguous comments on two amendments that she would, in fact, support, demonstrate that the government either did not ask her or did not include her in the process, and that the Senate is well within its realm to consider those specific amendments proposed and send them back to this place for proper consideration.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Mr. Speaker, I have spoken in the House before about my experience with MAID, where I was with a very beloved and dear family member. It was a very beautiful but sad day. I will always be grateful for that experience.

One of the things that is so important to me is the use of language. I want to be very clear that it is important that we do not use the word “suicide” in this. This is about a human being managing their own life journey. They are looking at a foreseeable death and they want to die in the best way they possibly can.

Could the member talk about the importance of language and making sure that, as we go through this process, we are very respectful of the people who have to make decisions about how they choose to leave?

[Peter Kent, Conservative, Thornhill, ON]

Mr. Speaker, indeed, language is important. Bill C-7, in many ways, has blurred the lines with regard to the most vulnerable in Canada. That explicit language should be and I hope will be eventually added.

I must say to her first point that I do not agree with the characterization of medically assisted death as suicide. I believe it is about determining by a profound, personal and dignified choice the manner of an unavoidable outcome.

[Elizabeth May, Green, Saanich—Gulf Islands, BC]

Mr. Speaker, I was tremendously moved by the hon. member for Thornhill's speech. The riding I represent is Saanich—Gulf Islands. I would have been, had I lived there then, the member of Parliament for Sue Rodriguez. She lived in North Saanich. Her struggle and her courage made an indelible impact, certainly on my constituents. That is one of the reasons I am so grateful that Parliament is moving forward.

I just wanted to thank the hon. member for the honesty and personal nature of his comments. I am so glad that he is well and over cancer. Please God it remain so.

[Peter Kent, Conservative, Thornhill, ON]

Mr. Speaker, I thank the member for her very caring, kind and gracious words. I look forward to our paths crossing again in the House, in this place, rather than by this imperfect hybrid means.

[Dane Lloyd, Conservative, Sturgeon River—Parkland, AB]

Mr. Speaker, in a previous speech at second reading, I noted how, perhaps 50 years from now or even sooner, we may look back on this era and these debates and ask ourselves how we could have been so foolish. History is filled with examples of ideas that were socially acceptable, celebrated or even considered the most moral option, but these ideas and policies were later shown to callously disregard the rights and dignity of individuals and communities.

As the bill went to the justice committee, I held out hope that parliamentarians would listen to the concerns of the disabled and other vulnerable Canadians who were sounding the alarm on the legislation and its implications for their lives. I hoped that the committee members would consider passing amendments to protect the vulnerable, such as extending reflection periods, which are the amendments that we are debating today, so that people would not feel that they are being rushed into medical assistance in dying.

Despite the overwhelming and compelling evidence, the committee majority really chose to ram through the bill with little consideration. There were only five meetings to hear witnesses, and of those five meetings, the majority were with the proponents of medical assistance in dying and there was very little opportunity, relatively, to hear from those who had concerns about the bill. This amounted to a mere hours of debate on an issue that is literally about the life and death of Canadians.

It is just wrong that the government is trying to ram through this important legislation in an expedited manner without taking time to listen and include the concerns of those communities who are vulnerable. It appears that the Liberals do not really want to listen to criticism or work to improve the bill and that they want to implement their agenda, regardless. In doing so, I believe they are ignoring the voices of disabled people, indigenous people, doctors and many others who have raised concerns.

In dealing with the amendments today, I am very pleased that my Conservative colleagues have strongly put forward these amendments related to the 10-day reflection period. I believe that the defeat of this amendment is removing a very basic safeguard for the protection of the vulnerable. The government claims that this would only apply to those with a reasonably foreseeable death and that there should not be a reflection period. However, we have seen the evidence that people who would not be under the existing legislation, individuals who do not have a reasonably foreseeable death, are receiving medical assistance in dying under the current legislation. The government has not strengthened or clarified the definition of what is reasonably foreseeable. The Liberals are actually planning to remove it as a requirement entirely.

I do not believe that the two streams the Liberals are talking about would apply any protections. The reflection period is essential to give Canadians the opportunity to make a decision and then revisit that decision after deep reflection. I understand that no decision to pursue MAID is taken lightly, but by accelerating the timeline between the decision and the receipt of MAID, we are removing an opportunity for reconsideration.

I also do not believe that doctors are always in the best position to consider underlying mental health conditions. If someone comes in and seeks medical assistance in dying with this new expedited timeline, doctors may not be equipped to recognize people with mental health challenges. It could be that those struggling with their mental health will receive medical assistance in dying without their family being informed and without an opportunity to offer treatment or an intervention. This is obviously a very real and dangerous possibility. In fact, it has already happened.

According to testimony from Dr. Trudo Lemmens and in a recent article in Maclean's magazine, people have been seeking and granted MAID because they do not want to live with financial difficulties and loneliness. This is wrong. When did poverty get added to the list of justifications for accessing MAID? I have yet to see it in any legislation, but we are seeing it happen here, right in front of our eyes.

We must also consider that the will to live can fluctuate. Put simply, people who need to make a life-and-death decision must have the opportunity to reflect on that decision over a period of time. Dr. Harvey Chochinov, who gave testimony at committee, reported:

Our research group reported that the will to live can be highly fluctuant over intervals as short as 12 to 24 hours. In fact, 40% of patients who were prescribed lethal drugs in Oregon decided not to take [the drugs].

We also know that people facing chronic conditions may be suffering from suicidal ideation, but if they are given some time, they might choose not to follow through with that. It is clear that when it comes to issues of life and death, it is not black and white. The will to live, to continue on and to overcome can change over time.

Expanding further on the definition and enforcement of “reasonably foreseeable death”, the requirement that a death be reasonably foreseeable was one that a broad group of people could support in 2016, but since 2016, we have seen it abused in ways that people could not have imagined. One recent case comes to mind. Nancy Russell, an elderly woman who was struggling with pandemic-induced isolation, underwent MAID recently in order to, reportedly, avoid another lockdown.

I want to take a moment to say that my thoughts are with her family who recently faced this loss. I know it is not an easy situation. Nevertheless, this is a pertinent example of medical assistance in dying being provided when there was no apparent reasonably foreseeable death. Some have argued that old age in itself is a qualifier for reasonably foreseeable death, although that argument was not made when the original legislation was put forward. It was not the understanding of the public at the time we accepted this.

In this case, however, if COVID-19 had been eradicated and a further lockdown avoided, it is very likely that this woman and maybe several others would not have pursued an assisted death. Therefore, it is clear to me that the reasonably foreseeable requirement has not been respected and is not being enforced or even defined well by the Liberal government.

Let us dive deeper. “Reasonably foreseeable” is not even considered a medical concept. Professor Alain Naud from Laval University stated in his testimony, “The term does not meet any medical concept or definition. It doesn't exist in any medical textbook. Yet it is the responsibility of physicians to assess the eligibility of patients.” The Canadian Bar Association, David E. Roberge, also stated that reasonably foreseeable death has caused “significant uncertainty in practice, and Bill C-7 does not give any guidance on how to apply it.”

Instead of doing the right thing and defining the terminology for the medical community, the government and the committee majority have decided to just remove the safeguard altogether. Clearly, the bill needs further study and clarity, because when it comes to life and death, doctors need a clear set of rules and guidelines, and the bill really fails to provide that.

When I listened to the Minister of Health's committee testimony, she talked about the need to create two streams, one for those with a reasonably foreseeable death and another for those without a reasonably foreseeable death. Since the definition of “reasonably foreseeable” is so ill-defined and subject to abuse, the so-called safeguards for the vulnerable in this case are not worth the paper they are written on. The fact is that there is no desire to intervene to protect the lives of vulnerable people and I firmly believe that once the next parliamentary review is completed, we will see the further removal of any safeguards.

Another point on this feature is that the concerns of the correctional investigator, Dr. Ivan Zinger, were not included in the committee study or in any of the recommendations. Dr. Zinger has raised deep concerns about medical assistance in dying in Canada's prisons and believes that there has been some abuse of process. I agree with his assessment. Prisoners with limited rights being granted medical assistance in dying is a deep, moral and ethical problem, and it is a problem that the committee chose not to deal with. He has even called for a moratorium on MAID in Canada. I did not see his testimony included. His concerns have not been raised or addressed and that is a real failure of the bill.

This brings me to another concern, which is that it seems the government wanted to use the bill as an opportunity to circumvent the will of Parliament. Ironically, it was the will of the last Parliament, when Liberals had a majority government, that we would have a mandated five-year parliamentary review.

The government saw an opportunity with the Truchon decision. Even in the Minister of Justice's own testimony at committee, he said that they saw this as an opportunity to get something done before the five-year review. It kind of undermines the whole point of a review when we need more time. This is a radical departure from where we have been as a country and we need time to experience this and come to a new understanding as a country. We have just short-circuited that review and are pushing forward with the legislation.

In closing, I am pleased that we have brought these amendments forward. I hope we will give them their full consideration so that we can protect the lives of vulnerable people.

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the President of the Queen’s Privy Council for Canada and to the Leader of the Government in the House of Commons]

Mr. Speaker, there is no conspiracy here. The coronavirus and the court's decision from the province of Quebec are important realities that we have to face.

The member said the government is ramming this legislation through. Need I remind the member that this is a minority government, which cannot ram things through without working with other political parties. Members of the Green Party, the New Democrats and the Bloc are supporting the legislation, from what I understand.

I am wondering if the member could provide his thoughts on the idea that the majority's will is of more than one political party. This does not amount to ramming.

[Dane Lloyd, Conservative, Sturgeon River—Parkland, AB]

Mr. Speaker, this does not change the facts related to a bill dealing with an issue as important as the life and death of Canadians and changing the Criminal Code, regardless of whether other parties are supporting it or not in a minority Parliament. The fact is that we had only five meetings, the majority of which were with officials and people who have an interest in getting this legislation passed, and had relatively few meetings with people who are raising concerns about the bill. Therefore, yes, it absolutely is being rammed through.

If the government had not prorogued this summer, perhaps we would have had more time to thoughtfully consider this legislation and put forward some real, common-sense amendments.

[Alexandre Boulerice, NDP, Rosemont—La Petite-Patrie, QC]

Mr. Speaker, I would like to thank my colleague for his speech.

I think it is important to put this debate back in its context. Indeed, the Supreme Court rejected the previous law saying that it violated certain rights. We have obtained two extensions now to adopt a new draft of the bill. We must comply with the Supreme Court ruling, but we must also have a law that allows people to die with dignity and avoid unnecessary suffering.

Is this not a laudable goal that merits our support?

[Dane Lloyd, Conservative, Sturgeon River—Parkland, AB]

Mr. Speaker, I think the member is mistaken. The bill was never taken to the Supreme Court of Canada. It has not had an opportunity to weigh in on this because the government chose not to appeal the decision and defend its own legislation, which it had just passed a few years earlier with broad support from many parties in the House of Commons.

Parliament made a statement and passed a law. To allow it to be overturned so fundamentally in a period of just a few short years really just shows the momentum on this. The government is pushing for further removals of safeguards and it is shocking. Of course, we want to do things to stand up for the dignity and autonomy of individuals, but that cannot come at the expense of vulnerable people, the disability community and others who have concerns over this legislation.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Mr. Speaker, I share my colleague's concern about the government's choice not to do a five-year review. That review was supposed to show whether people were following the first rules that were put in place. There are many anecdotal stories about where those rules were not followed, so to further remove the safeguards is quite troubling.

Has the member heard anecdotal stories in his riding where the rules were not followed? They would emphasize the need for this five-year review before we go further.

[Dane Lloyd, Conservative, Sturgeon River—Parkland, AB]

Mr. Speaker, I want to recognize my hon. colleague for her great work on fighting for better palliative care access for Canadians. This COVID pandemic has shown us how important it is to ensure that our seniors and those with disabilities who are living in extended care homes are properly treated and properly cared for. We should not have a situation where treatment is so limited that people are choosing medical assistance in dying as an alternative to health care.

I know the five-year review is going to happen, but my concern is that we did not wait. We did not give more time to study this legislation before moving forward with such a fundamental rewrite of our understanding of it.